Insurance Dispute Lawyer Blog

Insurance Coverage Turns On Distinction Between Flood Damage And Mechanical Issue

Published on: September 6, 2023 | By Berniard Law Firm

dsc05934_0-scaled Dealing with the aftermath of a flood is never fun. This is especially true when the flood damages one of your vehicles. This is the situation Michael Jacobs found himself in after one of his cars was damaged in a flood. After a long fight with his insurance company, he eventually prevailed and was awarded damages.

Jacobs owned multiple vehicles that GEICO insured. His parish in North Louisiana was affected by heavy flooding. When the flooding started, Jacobs and his brother tried to move the vehicles from his house to higher ground but were unable to remove them before the floodwaters rose, so they could not drive up to the house. Jacobs waded through the floodwater to retrieve one of the vehicles, a 2001 Honda Accord. In the days following the flood, the Honda kept overheating. Jacobs claimed this had only occurred after the flood.

Jacobs submitted a claim to GEICO for the damage to the vehicle. The insurance inspector did not identify any flood-related problems and determined the upper radiator hose had blown out. Another mechanic gave Jacobs an opinion and concluded there were issues with his spark plugs. GEICO ultimately denied Jacobs’ claim because it had suffered a mechanical failure that was not flood-related. Jacobs filed a lawsuit against GEICO, alleging his Honda had been damaged from the flooding. At trial, the court ruled the Honda had suffered water damage and awarded vehicle property damages and attorney fees. GEICO filed an appeal.

Trial Court Errs by Granting an Exception of Prescription to Insurance Company

Published on: September 5, 2023 | By Berniard Law Firm

clocks_clock_time_watch-scaled Prescription. Some may relate this term to the medical field and taking pills. But in Louisiana, it has an entirely new meaning. Think of the common phrase “the statute of limitations” many other states use. It’s just like that. A limit is set that blocks claims from being brought after a certain amount of time has passed from the original incident. In this case, the Fifth Circuit Court of Appeal addresses whether an insurance company’s peremptory exception of prescription could be sustained.

On July 21, 2012, Michael Jones rear-ended Carlos Russell (“plaintiff”) while both vehicles were parked, waiting to unload their dump trucks in Belle Chasse, Louisiana. At the time of the incident, Jones was within the scope of employment with Riley & Carroll Properties (“R & C”). Determining the scope of employment is important because an employee can only collect worker’s compensation benefits for any injuries that arise within the scope of employment. After the accident, State National Insurance Company (“SNIC”) paid Carlos Russell $8,738.52 for property damage to his vehicle.

Exactly one year later, on July 21, 2013, Russell filed a personal injury claim against R & C, Jones, and SNIC. Later, Russell amended the lawsuit to include his own insurance company and Ernest Riley, the trucking company’s owner, as defendants. It was found later in 2017 that Scottsdale Insurance Company carried general liability insurance coverage for Jones, Riley, and R & C. That meant that Russell could also add Scottsdale as another defendant to the claim.

Injured Employee Entitled To Select One Physician Of Choice in Workers’ Compensation Claims

Published on: September 4, 2023 | By Berniard Law Firm

workers_construction_worker_work-scaled If you are injured on the job, one of your primary concerns is likely finding competent medical care. Under the Louisiana Workers’ Compensation Act, injured workers can select one physician of any specialty without their employer’s approval. What happens if your employer refuses to pay for your selected physician?

Marvin Ray Scott brought a workers’ compensation claim against his employer, Packaging Corporation of America (“PCA.”) Scott claimed he had lost his hearing because of his work at the Boise Paper Mill in DeRidder, Louisiana. Scott then filed a motion to have an expedited hearing under La. R.S. 23:1121. Scott claimed PCA had not authorized his initial visit to his selected physician. PCA responded, claiming Scott had improperly used summary proceedings because he was not just trying to get approval for his selected physician, but he was also seeking attorney’s fees and penalties. At the hearing, the workers’ compensation judge ruled in favor of Scott and ordered PCA to pay Scott’s relevant medical bills and pay separate penalties and attorney’s fees, totaling $7,000. PCA filed an appeal.

Louisiana Workers’ Compensation Act sets forth rights and remedies for injured workers. Under La. R.S. 23:1121, an employee is permitted to select one physician of any specialty without their employer’s approval. If the employer denies that, the employee is entitled to an expedited proceeding. Under La. R.S. 23:1201(F), the employer can also be required to pay penalties and attorneys’ fees if it does not comply with its statutory obligations to an injured worker.

Doctor Held Not Vicariously Liable For Physical Therapist’s Actions by Louisiana Court

Published on: September 3, 2023 | By Berniard Law Firm

courthouse_311_jarvis_st-scaled When you think about medical malpractice lawsuits, a botched surgery or missed diagnosis are likely the first things that come to mind. The following case involves a less common situation involving purported medical malpractice involving physical therapy post-surgery. It analyzes the relationship between a doctor and a physical therapist and whether a doctor can be vicariously liable for the actions of a physical therapist.

Jean McKeogh underwent a total shoulder arthroplasty, which Dr. Michael O’Brien performed. Following the surgery, Dr. O’Brien saw McKeogh for office visits at a Tulane University clinic. Part of McKeogh’s follow-up care involved physical therapy, which was located in the same building as Dr. O’Brien’s offices. McKeogh went to physical therapy but subsequently told Dr. O’Brien she thought she had been injured during it. A CT scan showed she had fractured her elbow. McKeough then had a frozen shoulder and had to have a second surgery.

As a result of the injury and alleged negligence, McKeough requested a medical review panel. In her complaint, she claimed Dr. O’Brien had not used reasonable care with respect to his post-surgery care for her, including with respect to the physical therapy he prescribed. The medical review panel determined Robin Silverman, the physical therapist, had not satisfied the applicable standard of care. However, the medical review panel found there was no evidence to support a finding that Dr. Brien and Tulane had not met the applicable standard of care.

Can a business be liable if a patron slips and falls on a wet walkway?

Published on: September 2, 2023 | By Berniard Law Firm

addiction_bet_betting_casino-scaled Lawsuits involving slip and fall accidents are widespread. However, specific requirements must be satisfied to prevail in a slip-and-fall case. The following lawsuit helps answer the question: Can a business be held liable if a patron slips and falls on a wet walkway?

While walking with her son in the Treasure Chest Casino parking lot, Linda Cangelosi slipped and fell under the outdoor tent that covered part of the walkway entrance into the casino. Cangelosi slipped while stepping from the roadway to the walkway. At the time of her fall, the ground was wet, with puddles. After he fell, employees of Treasure Chest Casino assisted Cangelosi and called an emergency team. Cangelosi declined their offer to transport her to the hospital and continued to the casino. However, about 45 minutes later, she left because her hip hurt. She consulted with a doctor, who provided her with pain medication. Since the accident, Cangelosi had to use a walker and has been in pain. Cangelosi filed a lawsuit against Treasure Chest Casino. Both Cangelosi and Treasure Chest Casino filed motions for summary judgment. The trial court granted Treasure Chest Casino’s summary judgment motion. Cangelosi appealed.

Under La. C.C. art. 2317, the owner of a thing is liable for damage if they knew or should have known about the defect that causes damage, which could have been prevented if the owner had exercised reasonable care. Further, under La. C.C. art. 2322, this also applies to building owners. Therefore, if Cangelosi provided sufficient evidence that Treasure Chest Casino knew or should have known about the wet walkway that caused her slip and did not act reasonably, she could prevail in her lawsuit.

Management Company Not Qualified As Additional Insured In Cleaning Company’s Insurance Policy

Published on: September 1, 2023 | By Berniard Law Firm

ladder_art_red_garden-scaled It can be challenging to interpret insurance policies, especially when they involve complex provisions such as coverage for an additional insured. Before signing an insurance policy, it is imperative to understand its language and what it does and does not cover. Here, the plain language of the insurance policy proved instrumental in the appellate court’s ruling.

Pamela Sloane was injured while working for Integrity Cleaning Services (“Integrity”) at Forestwood Apartments. She was cleaning a ceiling fan while standing on a ladder. She inadvertently touched an exposed wire, which electrocuted her, and she fell from the ladder. Sloane filed a lawsuit against CLK Multifamily Management (“CLK”) and others. Sloane claimed CLK had not adequately maintained the premises or warned of the dangerous condition of the exposed wire. CLK filed its answer to the lawsuit, denying the allegations, and added Travelers Indemnity (“Travelers”) to the lawsuit. CLK claimed Integrity was contractually required to have a general liability insurance policy that covered CLK as additional insureds.

Travelers filed a summary judgment motion, claiming CLK was not an additional insured under the policy. Travelers attached a copy of the relevant insurance policy to its summary judgment motion. CLK disagreed and claimed it was indeed an additional insured. The trial court concluded CLK was not qualified as an additional insured and granted Travelers’ summary judgment motion.

What Is An Occupational Disease Under The Louisiana Workers’ Compensation Act?

Published on: August 31, 2023 | By Berniard Law Firm

green_mold_harmful_mold If you have experienced symptoms from working in a moldy work environment, you might think you are entitled to recover from your employer. However, navigating the Workers’ Compensation system can be challenging partly because of the distinct and often complicated vocabulary in the statutes. This case involves defining an occupational disease under the Louisiana Workers’ Compensation Act.

Angela Lyle worked in the payroll department at Brock Services. Her office was in a trailer in Norco, Louisiana, at the Valero plant. Lyle claimed she saw mold throughout the trailer that increased over the two years she worked at the site. She suffered from fatigue, burning eyes, sores, and other symptoms. After suffering a nosebleed, she underwent a medical evaluation. Testing confirmed mold was present in the office, so Lyle’s trailer was replaced. Once the trailer was replaced, some of Lyle’s symptoms went away, but others persisted, and new symptoms emerged.

She resigned and was diagnosed with sarcoidosis in her lungs and lymph nodes. She then filed a claim with the Workers’ Compensation, claiming she had suffered an occupational disease and was entitled to damages. The workers’ compensation judge denied her claim as neither her mold exposure nor the development of sarcoidosis qualified as an occupational disease or accident under the Louisiana Workers’ Compensation Act. Brock filed a summary judgment motion, arguing Lyle could not establish sarcoidosis was an occupational disease. The workers’ compensation judge granted Brock’s summary judgment motion, finding Lyle’s sarcoidosis was not an “occupational disease. Lyle appealed, arguing the workers’ compensation judge ignored the definition of an “occupational disease” under the Louisiana Workers’ Compensation Act.

Contra Non Valentem Inapplicable To Lawsuit From Lung Cancer Death

Published on: August 30, 2023 | By Berniard Law Firm

nuclear_waste_radioactive_trash-scaled Even in cases involving tragic factual situations, strict procedural requirements must be followed to prevail on your claim. This case involves the time limits in which you must file a lawsuit and the principle of contra non valentem, which is a rule that the time limit in which someone has to file a lawsuit does not start if the other person was hiding information that would allow them to bring their claim.

This case involves the tragic death of a husband and father, Julius Lennie. Tuboscope employed him for over thirty years. Various oil companies hired Tuboscope to clean and refurbish pipes and tubes used in the oilfield. The clean process involved the emission of a naturally occurring radioactive material. In 2010, after retiring, Lennie was diagnosed with lung cancer and died shortly thereafter. Almost four years later, his spouse and children filed a lawsuit against various companies that had hired Tuboscope.

His surviving family claimed Lennie had been exposed to dangerous levels of radiation while working, which caused his cancer and death. They alleged the companies knew naturally occurring radioactive materials were dangerous but had not warned Lennie or taken appropriate corrective actions. The Lennies argued they had filed the lawsuit after reading an article about radiation exposure in pipe yards, so they were not on notice of their claims until September 2013.

Understanding Statutory Employer Immunity in Workers’ Compensation Cases in Louisiana

Published on: August 29, 2023 | By Berniard Law Firm

ladder_step_ladder_passage-scaled Statutory employer immunity is critical in determining liability and compensation for workplace injuries in workers’ compensation. The following case is an example where the court had to decide whether the defendant was entitled to statutory employer immunity under the dual contract theory provided for in La.R.S. 23:1061(A)(2). We will examine the facts of the case, the arguments presented by both parties and the court’s decision. We will also examine the legal framework surrounding statutory employer immunity and its impact on workers’ compensation cases.

The case involves Patrick Cummins, a worker hired by a subcontractor to perform its contract with R.A.H. Homes and Construction, LLC (“R.A.H.”), the defendant. The homeowners had contracted R.A.H. to construct a single-family home, including the installation of an attic HVAC system. Cummins became seriously injured when the attic access ladder malfunctioned, and he fell while performing the work required under R.A.H.’s contract with the homeowners.

Cummins sued several defendants, including R.A.H., in tort, alleging that R.A.H. was directly responsible for the improper installation of the attic ladder that led to the accident. In response, R.A.H. asserted an affirmative defense of statutory employer immunity under La.R.S. 23:1061(A)(2), claiming that a statutory relationship existed through the two-contract theory.

Who’s At Fault if your car is stolen then involved in a wreck? The Thief, Victim, or Third Party Owner? (One Judges Dissenting Opinion)

Published on: August 28, 2023 | By Berniard Law Firm

car_burglary_thief_burglar-scaled In the legal system, dissenting opinions, i.e., opinions delivered by one or more judges who disagree with the decision, play a crucial role in shaping the interpretation and application of the law. They provide valuable insights into alternative viewpoints, often sparking discussion and debate and ultimately leading to the evolution of jurisprudence. One such notable dissenting opinion can be found in the case of Christopher Blanchard v. Demetrius J. Hicks et al., authored by Justice Cooks. In this blog post, we look at the case, the arguments made in the dissent, and the importance of dissent in the legal landscape.

The case of Christopher Blanchard v. Demetrius J. Hicks et al. arose from an incident in which Officer Blanchard’s patrol car was struck by a stolen truck. The plaintiff, Officer Blanchard, alleged that the defendant, Demetrius J. Hicks, was negligent in leaving his vehicle unattended with the keys in the ignition and the engine running, thereby facilitating the theft that led to the accident.

The majority of the court relied on the precedent set by the Supreme Court’s decision in Racine, which held that leaving keys in a vehicle does not create liability for the motorist if a thief steals the car and causes injury to a third party. However, Judge Cooks dissented from the majority’s opinion, arguing that Racine does not dispose of the factual matter at hand.